A Novel Minimally Invasive Technique of Using Tooth-Borne Hyrax Expansion Screw for Distraction Osteogenesis of Large Alveolar Cleft Defects (HYDIS-TB)

Abstract

Because of the high failure rates, large alveolar cleft defects cannot be successfully closed with bone grafting. Vega introduced the use of the hyrax screw for the closure of such defects by distraction osteogenesis. However, his technique was more invasive with a difficult adaptation of the appliance at the surgical table. To overcome these limitations, a completely tooth-borne trifocal distraction appliance was devised and placed after osteotomy in a 22-year-old repaired group 3 cleft patient who had a 15-mm alveolar defect on the right side. The tooth-borne trifocal distraction appliance was successful in the controlled closure of a large alveolar cleft with minimal invasiveness and low costs making this procedure feasible for a greater number of patients.

Interim use of Hyrax Screw Assembly for Single-Step Closure of Small Alveolar Cleft before Anterior Maxillary Distraction Osteogenesis

“… 1 , 9 The tooth-borne trifocal distraction appliance involving the use of 2 Hyrax screws has also been described for the controlled closure of a large alveolar cleft. 12 In cases of small alveolar clefts with enhanced chances of graft survival, bone grafting is an ideal option for the closure of cleft defects to achieve arch continuity, stabilise the maxillary segments, eliminate oronasal fistulae, optimise nasal morphology through nasal alar cartilage support and finalise implant placement. 13 However, before the commencement of AMDO, a waiting time of at least 3–6 months is recommended for the stabilisation of the graft.…”

“…the activation of the appliance by opening the screw) has been widely documented in the literature. 9 , 12 The majority of these applications involving a Hyrax screw and a fan-shaped screw entail the opening of the screws to facilitate the approximation of the alveolar segments towards each other. 8 , 12 , 14 On the other hand, the present technical note describes the novel application of the modification of the Hyrax screw, where a conventional Hyrax screw, after being fully opened, was utilised as an interim assembly for accomplishing single-step closure of a small alveolar cleft of up to 5 mm before the commencement of anterior maxillary DO.…”

“… 9 , 12 The majority of these applications involving a Hyrax screw and a fan-shaped screw entail the opening of the screws to facilitate the approximation of the alveolar segments towards each other. 8 , 12 , 14 On the other hand, the present technical note describes the novel application of the modification of the Hyrax screw, where a conventional Hyrax screw, after being fully opened, was utilised as an interim assembly for accomplishing single-step closure of a small alveolar cleft of up to 5 mm before the commencement of anterior maxillary DO. The present interim tooth-borne Hyrax screw assembly facilitated controlled mobilisation, docking and close approximation of the bony segments (without the over-riding of segments) towards the defect.…”

Orthodontic Pre Grafting Closure of Large Alveolar Bony and Soft Tissue Gaps: A Novel Nonsurgical Protraction of the Lesser Segments in Growing Patients With Cleft Lip and Palate

“…In the literature, many of the cleft patients who received segmental maxillary distraction were adults or at least beyond their pubertal growth spurt (Liou et al, 2000; Dolanmaz et al, 2003; Yen et al, 2005; Bousdras et al, 2014; Neha et al, 2018). In younger patients, as presented in this article, it is possible to protract the maxillary bone without surgery since the maxillary segments are still separated by patent circum-maxillary sutures.…”